NURSING CARE PLAN

OSTEOPOROSIS

Name: CASSEY MAE M. CUREG Year & Section: BSN 3 – C

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Impaired physical Short Term: 1. Monitor patient’s vital 1. To determine any changes Short Term:
Patient reports mobility related After 8 hours of nursing signs. for baseline comparison. After 8 hours of nursing
difficulty in moving to activity intervention the patient intervention the patient
due to lower back intolerance as will: 2. Ensure patient’s safety. 2. Nurse’s top priority is to was able to:
pain for the last few evidenced by  Verbalize relief of provide safety.  Verbalize relief of
weeks in the lower pain and limited pain. 3. Note factors affecting pain.
lumbar area. range of motion  Display relaxed current situation and 3. Identifies potential  Display relaxed
“The pain is (ROM) manner; able to potential time involved. impairments and manner; able to
becoming worse and participate in determines type of participate in
it is keeping me from activities, sleep/rest 4. Assess client’s interventions needed to activities, sleep/rest
doing my daily appropriately developmental level, provide for client’s safety. appropriately
activities.” as stated  Compliant with motor skills, ease and  Compliant with
by the patient. prescribed capability of movement, 4. This is to determine prescribed
pharmacological posture and gait. presence of pharmacological
Objective: regimen. characteristics of client’s regimen.
 Age – 52 y/o  Regain or maintain 5. Note older client’s unique impairment and to  Regain or maintain
 Gender – Female mobility at the general health status. guide choice of mobility at the
highest possible intervention. highest possible
 BP – 130/70 level. 6. Evaluate presence and level.
 PR – 72 bpm degree of pain, listening 5. While aging, perse, does
 RR – 18 cpm Long Term: to client’s description not cause impaired Long Term:
 T – 36.5 c* After 1 – 2 weeks of about manner in which mobility, several After 1 – 2 weeks of
nursing intervention, the pain limits mobility. predisposing factors in nursing intervention, the
 Facial Grimace patient will maintain addition to age-related patient has maintained
 Pain scale 7/10 functional mobility as 7. Ascertain client’s changes can lead to functional mobility as
 Limited Range of long as possible and perception of activity immobility. long as possible and
Motion. within limitations. and exercise needs and within limitations.
 Verbalization of impact of current 6. To determine if pain
problem and situation. Identify management can improve
request for cultural beliefs and mobility.
information. limitations.
 Guarding and 7. Helps to determine
tenderness upon 8. Determine history of client’s expectations and
palpation. falls and relatedness to beliefs related to activity
 Pain is fairly current situation. and potential long-term
localized, effect of current
without 9. Asses nutritional status immobility. Also identifies
radiation. and client’s report of barriers that may be
energy level. addressed.

10. Determine presence of 8. Client may be restricting

complications related to activity because of
immobility. weakness or debilitation,
actual injury during a fall,
11. Instruct or assist in the or from psychological
use of siderails, distress that can persist
overhead trapeze, roller after logical distress.
pads walker, and/or
cane. 9. Deficiencies in nutrients
and water, electrolytes,
12. Support affected body and minerals can
parts or joint using negatively affect energy
pillows, rolls, foot and activity tolerance.
supports or shoes, gel
pads, etc. 10. Effects of immobility are
rarely confined to one
13. Provide range of motion body system.
exercises every shift.
Encourage active range 11. For position changes,
of motion exercises. transfers and to facilitate
 safe ambulation.
14. Encourage participation
in diversional or 12. To maintain position of
recreational activities. function and reduce risk
Maintain a stimulating of pressure ulcers.
environment (radio, TV,
newspapers, personal 13. Helps to prevent joint
possessions, pictures, contractures and muscle
clock, calendar, visits atrophy.
from family and friends).
14. Provides an opportunity
15. Instruct patient or assist for release of energy,
with active and passive refocuses attention,
ROM exercises of enhances patient’s sense
affected and unaffected of self-control and self-
extremities. worth, and aids in
reducing social isolation.
16. Administer medications
prior to activity as 15. Increases blood flow to
needed for pain relief. muscles and bone to
improve muscle tone,
17. Provide client with maintain joint mobility;
ample time to perform prevent contractures or
mobility-related tasks. atrophy and calcium
resorption from disuse.
18. Instruct family regarding
ROM exercises, 16. To permit maximal effort
methods of transferring and involvement in
patients from bed to activity.
wheelchair, and turning
at routine intervals. 17. --
18. Prevents complications of
19. Collaborate with immobility and knowledge
 physical medicine
specialist and
occupational or physical
therapists in providing
range-of-motion 19. To develop individual
exercise (active or
passive), isotonic muscle
contractions, assistive
devices and activities.
20. Discuss safe ways that
client can exercise.
assists family members to
be better prepared for
home care.
exercise mobility
program, to identify
appropriate mobility
devices, and to limit or
reduce effects and
complications of
immobility.

21. Encourage 20. Multiple options proved

client’s/significant client choices and variety.
other’s (SO’s)
involvement in decision- 21. Enhances commitment to
making as much as plan, optimizes outcome.
possible.
22. …
22. Review importance and
purpose of regular 23. Multiple options provide
exercise client choices and variety.

23. Discuss safe ways that

client can exercise.